Osteoporosis in menopause: Causes, Symptoms and Prevention

Women in menopause make up the bulk of patients with osteoporosis. The disease is dangerous to its long latency over and may first appear spontaneous fracture with little damaging effect. For the prevention and treatment of bone softening disease, modern medicine has numerous techniques that allow to effectively deal with a reduction in bone mineral density.

The connection between menopause and osteoporosis

All women, without exception, to varying degrees, will disturb the symptoms of menopause, which is inevitably accompanied by a reduction in bone mineral density. This process involves the gradual leaching of calcium ions from the walls, bone plates. This process is associated with a decrease in estrogen production.

Receptors for female sex hormones are found not only in the genital organs, but also in the skin, hair, bones, blood vessels. By reducing the concentration of estradiol disturbed calcium-phosphorus metabolism, which leads to osteopenia - softening bone. Next, develop osteoporosis - a decrease in bone mineral density plates.

Osteoporosis is dangerous fractures, which require long-term rehabilitation and may cause disability.

Osteoporotic fractures can be avoided. Timely diagnosis, which is to assess bone density, you can start treatment as well as a number of measures that will prevent damage to bones.

Causes and factors

Osteoporosis is a disease of the skeleton that is a reduction in bone mass per unit volume, which is accompanied by serious violations of bone structure elements. These processes lead to an increase in the fragility, increase the likelihood of fractures.

The pathogenesis of skeletal disease in menopause is lack of harmony between the two processes, which always occur in the bone tissue resorption and bone formation. As a result, the bone quality is compromised so that fractures occur more often than in ordinary life. If you compare two identical dice a unit volume and patient young woman in menopause will be obvious smaller amount of bone in the same areas.

The quality of bone mass - is its mineral density. When menopause reduced content of essential minerals and violated due to hormonal changes, which leads to osteoporosis.

Defeat bone mass called the menopause with osteoporosis type 1 or postmenopausal osteoporosis in which the broken characteristic bases of bone resorption is increased it.

The basis of the bones - plates and partitions - trabeculae exposed to changes in the first place. This leads to a characteristic of the menopause fractures: distal (end) forearm, vertebral bodies.

In old age, when the symptoms of menopause is over, osteoporosis manifests hip fractures more often. Such fractures lead to disability, complete incapacitation, requires care for the patient, since the healing of the breach of integrity of the bone is held permanently.

Osteoporosis in menopause is a multifactorial disease. Menopause can occur in women without pathological fractures, but may be accompanied by frequent episodes.

fracture frequency during menopause It depends on the presence of complicating factors.

The factors leading to worsening of osteoporosis:

• heredity;
• receiving glucocorticoids for more than 3 months;
• presence of preexisting fractures;
• smoking;
• lack of physical activity;
• daily intake of alcohol (1 a beer bottle, 100 grams of the alcohol, 300 ml of wine);
• vitamin D deficiency;
• inadequate intake of dietary calcium;
• the presence of risk factors for falls (dizziness, blurred vision, hearing loss, dementia, disorders of the musculoskeletal system);
• existing skeletal diseases (rheumatism, etc.).

species

There are two main varieties of osteoporosis.

1. Primary, which relates osteoporosis and menopause as well as senile and senile osteoporosis. This kind of disease is caused by the natural extinction of reproductive function and decreased hormone production.
2. Secondary, which is caused by the pathology of other organs and systems, which leads to osteoporosis.

Secondary osteoporosis develops in the following situations:

• rheumatism;
• gastrointestinal diseases accompanied by malabsorption of trace elements;
• diseases of the endocrine system, violates the hormonal balance and the distribution of minerals in the bone;
• long-term use of glucocorticoids;
• treatment anticonvulsants;
• heparin;
• immunosuppressive therapy.

Women who have diseases that lead to a breach of the mineral composition of bone tissue exposed to a double risk of osteoporosis during menopause. Aggravation of pathological processes in bone that occur naturally during menopause, leading to significant more frequent fractures.

symptoms

Symptomatology of osteoporosis in menopause for a long time makes itself felt. Most often the first symptom of osteoporosis in menopause is broken when accidentally dropped. Fractures are located in the spine, the lower extremities (usually the upper).

Identifies a number of grounds on which it is possible to suspect an active osteoporosis in women during menopause:

• loss of height 4 cm over the past few years, or 2 cm for the current year;
• straightening lumbar bending and strengthening breast - "hook" back with a rounded upper portion;
• change of posture - stomach diverticulum, the appearance of the skin folds on the sides of the chest;
• shuffling gait;
• back pain;
• pain in the legs, at least in the hands.

complications

The gradual leaching of essential minerals from bone plates which form a support skeleton only eventually leads to fractures. Damage bone integrity during menopause primarily dangerous prolonged healing, recovery period.

The most serious complication of osteoporosis are fractures of the spine and femoral neck, which forms the hip joint. Damage to the vertebrae leads to disruption of the integrity of the spinal cord, which are conducting nerve paths to all the organs and limbs. Unsuccessful fracture during menopause can result in paralysis, complete immobilization.

hip fracture because of their anatomical features heals very long. In some situations it is necessary to conduct joint replacement surgery.

Diagnostics

To verify the diagnosis using several techniques. Diagnosis of osteoporosis in women is carried out comprehensively using instrumental methods, biochemical methods and biopsy followed by histological examination.

Diagnostics include:

• X-rays of bones;
• densitometry.

The easiest method is performed by bone radiography. In osteoporosis during menopause there are a number of characteristic features by which the pathology is diagnosed.

Informative zones to diagnose:

• thoracic and lumbar spine, and not all the thoracic vertebrae are informative when the diagnosis of osteoporosis in menopause, experts analyze the state of the vertebrae, since seventh;
• pelvis;
• hip area, especially in women, entering the stage of old age;
• brush and coming to her department.

After performing X-ray images, doctors carry out the analysis of the following indicators, which may be signs of bone disease in menopause:

• radiographic shadow density reduction;
• outer (cortical) layer thins vertebra;
• intraosseous trabecular pattern which is formed by baffles and bone plates vanishes. Vertebra appears to be empty;
• reduction and strengthening transverse striation vertical striations within the vertebrae;
• vertebral deformations, characteristic of osteoporosis during menopause (anterior and posterior wedge, "fish" vertebrae);
• signs of compression (compression) in 11.12 thoracic and lumbar vertebra 1;
• calcifications in the aorta.

Particular attention is paid to features, not characteristic of osteoporosis during menopause. These markers are used for differential diagnosis:

• vertebral pathology above 4 breast;
• flat vertebra.

spine x-ray in the diagnosis of osteoporosis is relevant in severe his degree in women, when more than 30% of bone mass has been lost

The severity of osteoporosis during menopause with the help of X-rays is difficult to determine, therefore, apply additional methods - bone densitometry study.

Densitometry is a set of diagnostic tests that evaluate important parameter - bone mineral density. Densitometry can diagnose early signs of osteoporosis when mineral loss is 2%.

Allocate following kinds of methods:

• ultrasound;
• CT scan;
• X-ray.

Among the methods of X-ray densitometry is the most effective dual X-ray densitometry of the lumbar and the hip (femoral component).

Screening method densitometry at menopause is the ultrasonic method.

By biochemical methods include blood tests and urine tests to determine the degree of leaching of calcium from the bones.

1. Analysis of blood ionized calcium, phosphorus, magnesium.
2. Analysis of morning urine calcium ions.
3. Analysis of daily urine to determine the degree of calcium absorption in the intestine.
4. Determination of the blood level of the enzyme alkaline phosphatase.
5. Determination of specific markers.

In osteoporosis that accompanies menopause, there is an increase in urine calcium content, as it is actively leached from the bones.

Biochemical osteoporosis diagnostic methods should be used in conjunction with other methods.

For markers include:

• forming a marker of bone matrix (Total P1NP), which will be increased in osteoporosis;
• vitamin D, while the leaching of calcium from the bones into the blood levels of the vitamin is low;
• osteocalcin, ascending in osteoporosis;
• alkaline phosphatase, elevated in osteoporosis.
• propeptide of collagen type 1 (P1NP), rising in the pathology;
• deoxypyridinoline collagen breakdown products, also increases the bone fracture during menopause;
• The C-terminal telopeptide of collagen type I in blood (PICP), which will be increased in osteoporosis.

For the full definition of subject and treatment of thyroid hormones, parathyroid glands.

The next step in determining the degree of destruction of bone tissue in osteoporosis in the menopause is a biopsy. This methodology allows for any disease diagnosed with the greatest accuracy.

Bone biopsy suspected osteoporosis is from the wing of the ilium. The method makes it possible to distinguish between osteomalacia and osteoporosis, to identify other bone disease, a type of mineral metabolism.

Initial changes in bone tissue, namely osteopenia - decrease of mineral density - is also the reason for the treatment.

Treatment

Therapy of osteoporosis during menopause is based on a combined approach, which involves hormonal agents (estrogen) and the replenishment of minerals losses. The main treatment is supplemented by physical therapy, diet and protective regime.

Medication

To stop the leaching of minerals from bone in step premenopausal and the menopause used several groups of drugs. All groups are divided into three types, pursuing different goals.

1. Medications that slow the leaching of minerals from the bones.
2. Drugs that stimulate bone formation.
3. Means multi-directional action.

The group of medications, stopping a decrease in bone mineral density include:

• estrogens (replacement therapy in menopause period);
• drugs that selectively modulate estrogen receptors;
• bisphosphonates;
• calcitonins;
• calcium supplements.

Comprehensive treatment of osteoporosis in women during menopause should be sure to include a calcium salt. Drugs are also used for prevention in women older than 40 years when the body begins a gradual adjustment.

Women in menopause You should receive daily 1000 mg calcium, postmenopausal - 1500 mg.

Not all calcium salts, which are contained in pharmaceuticals may ensure proper delivery and absorption of mineral. Thus, 1 g of calcium gluconate contains 90 mg of the element, whereas a carbonate or phosphate containing 400 mg of calcium.

Calcium salts are well tolerated by patients. For the prevention of kidney stones, calcium supplements should be taken during meals or after it. If the kidneys are healthy, a daily intake of 2500 mg of calcium will not lead to the formation of stones or a high content of calcium in the body. Therefore, when receiving the treatment and prevention of osteoporosis during menopause calcium supplements should not be afraid of an overdose in the aspect of consumption of dairy products. Simultaneously with the dosage forms of calcium can enrich the diet and food products containing this element.

Contraindication for administration of the calcium preparations are diagnosed laboratory hypercalcemia and hypercalciuria - allocation of a large number of cell in the urine and increased content in the blood.

So calcium can be absorbed in the body and have the desired effect in the prevention and treatment of osteoporosis, you need adequate intake of vitamin D. At the age of 50 years, the daily dose is 400 IU, over 50 years - 600-800 IU.

Widely used products containing a optimal dosage of calcium and vitamin D: Calcium D3 Nycomed, Calcemin.

In order to avoid a decrease in bone mineral density with a low level of estrogen for women in menopause hormone therapy is carried out. Depending on the individual features of different types of prescribed hormones.

1. A remote uterus taking medicines containing pure estradiol (Proginova, Estroferm).
2. In the absence of serious intervention on the uterus using means containing both estrogen and progesterone (Pauzogest, Angelica, Femoston, Divina, Tsikloproginova, Klimov, Kliogest).
3. External estrogens (Divigel, Estraderm, CLIMAR).
4. Steroids having a weak estrogenic and progestogenic activity (Livial, Tibalon).

It should be borne in mind that it is not always replacement therapy during menopause gives exclusively positive effect

Estrogens for the treatment and prevention of osteoporosis should be used under the supervision of the state of the mammary glands and the cardiovascular system.

In particular, the HRT should be prescribed after careful diagnosis of not only bones, but also other pathologies.

The optimal duration of hormone replacement therapy in menopause is 5-7 years with a careful diagnostic control.

Apart from estrogens, for the treatment of osteoporosis in menopausal agents which are not structurally hormones, but have the ability to bind to estrogen receptors. They are called selective estrogen receptor modulators.

Earlier Tamoxifen has been widely used, but its adverse effects on the endometrium does not allow to use the drug frequently. Modern representatives of the group considered Raloxifene, Lazoksifen, Bazedoxifene.

HRT mechanism of action is associated with inhibition of calcium leaching from the bones.

Bisphosphonates, which are also used for the treatment of osteoporosis, are able to bind tightly with lamellae inhibit leaching of calcium, long linger in the bones, almost toxic. Used drugs such as zoledronic acid Risedronate, Ibandronate, Pamidronate and others.

The preparations of stable strontium (salt thereof) is also used in the treatment of osteoporosis during menopause. Strontium forms bone tissue and ensures proper mineral density.

Furthermore, in the scheme of therapy often include calcitonin and parathormone (parathyroid hormone and thyroid glands).

Diet and exercise

To maintain the normal amount of weight a woman consumed calories per day should not exceed its energy costs. At moderate physical activity, sedentary lifestyle on average no more than 1600 kcal should be consumed per day (depending on the original data). Excess weight, as well as poor nutrition adversely affect bone health and may contribute to osteoporosis during menopause.

At home, you can perform simple physical exercises, which should begin with a warm-up warm-up banal. To do this, fit a circular motion in the shoulder girdle, walking on the spot, alternating stretching, twisting the hoop.

Among the exercises that will not hurt and will benefit are the following:

• exercise "cat";
• raising on tiptoes;
• alternate lifting feet from a prone position;
• pulling the legs to the abdomen of the supine position;
• rotation of hands, feet;
• "Scandinavian" walking.

Under the supervision of an instructor, you can engage in water aerobics. Every day, it is imperative to make walking, which can be a substitute for physical education.

Folk remedies

Among the popular methods of treating osteoporosis useful are those that normalize the status of bone mineral density. But you must use them in a complex drug treatment, exercise and diet.

The most popular herbal remedies are:

• decoctions of parsley and dill, saturated calcium ions;
• decoction of onion skins;
• infusion of wormwood collection, sleep-grass, dandelion, golden mustache;
• decoctions of chamomile, red clover (phytoestrogens sources).

In addition, a natural source of calcium is the egg shell. It must be clean, dry and grind in a blender. Should take with foods containing vitamin D. Among women who have entered into the phase of menopause, it is a popular mummy.

prevention

Allocate the basic preventive principles aimed at preventing the progression of osteoporosis and fractures in women who have reached the stage of menopause.

1. Good nutrition aimed at replenishing the loss of calcium, vitamin C, K, protein, minerals, and vitamin D.
2. Moderate physical activity.
3. Prevention of falls.
4. Exception of smoking and alcohol.

The optimal time of the prevention of osteoporosis is premenopausal, when the change in bone mineral density reduction aspect is just beginning.

LFK

A set of exercises for physical therapy should be selected rehabilitator, or orthopedic traumatologist. Any incorrect or inaccurate movement could cause injury. Therapeutic exercise is aimed at:

• improving blood circulation spine, hip joints;
• strengthening muscles and ligaments.

Banned all kinds of jumps, spins, the load on the spine, a quick run, jumps, combat, heavy lifting (over 5 kg).

Lifestyle

No matter how trivial did not seem recommendation on compliance with a certain way of life during menopause, but it is worth to take seriously.

Prevention of falls It is one of the important parts of the comprehensive prevention of fractures in menopause.

The careful, cautious woman would behave on a busy street, in a crowd, in bad weather, the smaller the risk of fractures and the disability it expects. hip fractures are very serious damage, requiring prolonged recovery.

Any disease that can lead to a fall, it is necessary to diagnose and treat. After 45 years, starting when the first symptoms of menopause, it is necessary to visit a neurologist, ophthalmologist, ENT physician in order to avoid pathologies that can lead to a drop of: violation of any origin, the auditory organ diseases, nervous diseases system.

Smoking and alcohol consumption at the beginning of osteoporosis are incompatible. It is necessary to limit the harmful habit.

Food

For the normalization of the bone tissue in the climax is required to comply with certain principles of nutrition. The diet should be rich in:

• dairy products containing large amounts of calcium ions (cheese, whole milk, cheese Adyg);
• fatty fish (salmon, mackerel, herring), which is enriched with vitamin D;
• nuts and seeds (almonds, sesame) containing calcium;
• soy phytoestrogen-rich.

It is necessary to properly combine foods: fish and meat should be consumed with vegetables, steamed or stewed. Instead of simple sugars useful to dried fruit snacks, nuts and seeds. Replace white bread baking wholemeal containing bran. Give preference to low-fat white meat. Fruits and vegetables should be introduced into the diet daily.

The amount of liquid should be at least 1.5 liters per day, but not more than 3 liters. The most useful is clean drinking water.